Some struggle to find care

CARSON CITY — Unemployed Las Vegas pharmacist Sheik Ellias told legislators Monday he can’t find doctors willing to operate on his two daughters, who both use wheelchairs.

Doctors won’t operate on daughters Hannah, 8, and Zaynah, 5, because payments from the state’s Medicaid program won’t cover their actual costs.

His girls suffer from cerebral palsy and leukodystrophy — a progressive degeneration of the white matter of the brain — leaving them unable to stand and in dire need of surgery. He also has a son with kidney problems.

"Taking care of them is really tough,” he said. "The issue right now is how to get treatment, which they require. Nobody’s taking Medicaid patients. As a single dad, it is really devastating to continue to be denied. I have no idea what to do."

Ellias spoke from Las Vegas via video conference during a pre-session hearing of the Senate and Assembly budget committees. His testimony put a human face on the suffering that some needy families are encountering in securing medical care in worsening economic times.

Legislators are reviewing Gov. Jim Gibbons’ $6.17 billion two-year budget proposal, which includes a 5 percent cut in what doctors and hospitals receive for treating Medicaid patients and caps enrollment at 25,000 in Nevada Check Up, a free health care program for poorer children. That is 40,000 less than the estimated number of children eligible for the program, though enrollment has typically fallen short of the number eligible.

The proposed Medicaid cut is on top of a 5 percent reduction approved by the Legislature in December.

Doctors have been complaining for years that Medicaid does not cover their treatment costs. Two physicians testified Monday that another 5 percent cut would prompt even more physicians to stop treating Medicaid patients.

During the hearing, Nevada Hospital Association President Bill Welch said Medicaid payments that hospitals receive from the state amount to 60 percent of the actual cost of treatment.

Medicaid is the state-federal program that provides health care for the poor, elderly, disabled and blind. Eligibility requirements are complex, but generally recipients can’t earn much more than the federal poverty level of $10,400 a year. Exceptions are made for those with disabilities and extreme medical problems, such as those suffered by Ellias’ daughters.

In contrast, children are eligible for Nevada Check Up whose parents’ combined annual earnings are no more than twice the poverty level.

Gibbons’ budget also does not replace any of the $55 million taken by the state from the counties’ indigent accident care fund during December’s special legislative session.

The governor concedes his budget is nearly $2 billion short of what is needed keep medical and other state services at the levels anticipated when the Legislature adjourned in June 2007.

Republican Gibbons won’t raise taxes unless the increases are backed by the general public.

The administration does not like to cut medical services, but "it is a money issue," said Charles Duarte, administrator of the state Health Care Financing and Policy Division.

Democratic leaders, however, said Monday they won’t accept the medical care budget cuts sought by Gibbons.

"We must find a compassionate and fair solution to our budget crisis," said Senate Majority Leader Steven Horsford, D-Las Vegas.

Noting that unemployment has jumped to 9.1 percent and could top 10 percent soon, Horsford said the number of people needing government-paid medical care only will increase.

Gibbons’ budget would destroy the safety net for people unable to pay medical costs, he added.

For Ellias, the safety net already has been destroyed.

Edwin Suarez, a pediatric physical therapist who has worked with Ellias’ daughters off and on the past two years, said leukodystrophy affects the central nervous system causing the two children to have problems with balance. Without proper medical care, what coordination and balance they do have will start to deteriorate.

"The more you stimulate, the slower the progression of the disease is,” Suarez said. "That’s why it is so important that these girls get proper care."

Suarez said there are three orthopedic surgeons in Las Vegas. All of them have stopped taking new Medicaid patients.

Other pediatric specialists also have stopped taking Medicaid patients, Suarez said.

"Mr. Ellias tried to get his daughters in to see a vision specialist, but they were turned away,” he said. "My office cannot absorb these cuts either. I’m not one for raising taxes, but I don’t really see any solutions.”

Doctors testified they simply cannot afford to keep treating Medicaid patients at the rates the state pays.

"There is nothing we want to do more than treat kids," said Las Vegas surgeon Dr. Mark Barry. "It is extremely difficult to operate under these conditions."

He said the amount of money he receives today for treating Medicaid patients is 55 percent less than what he was paid in 1994.

Ellias is unemployed because he quit his pharmacist’s job after his wife left him. His children need 24-hour-a-day care, he said.

The Ellias girls receive physical therapy three times a week. He estimates the cost to care for his two daughters ranges from $3,000 to $4,000 per month, not including surgeries.

Although Democrats have not yet backed tax increases or come up with their own budget plan, Assembly Speaker Barbara Buckley, D-Las Vegas, again called on citizens Monday to make suggestions to her nv2020.com Web site. Suggestions now include releasing all non-violent prisoners, establishing a four-day work week for state employees, taxing mining and legalizing gay marriages. Buckley also intends soon to re-examine all tax exemptions and abatements that the state has approved.

Hospital industry lobbyists were horrified by the medical care cuts proposed by Gibbons.

"We are talking about sick children," testified Larry Matheis, executive director of the Nevada State Medical Association. "They are children who need transplants, who have cancer, who need specialty care."

Duarte said the decision to cap Nevada Check Up and cut Medicaid reimbursement payments was made "strictly on finances." Because of the declining economy, Duarte said the number of Medicaid recipients is expected to increase by 11.5 percent to 220,864 on July 1, 2010, and to 239,472 on July 1, 2011.

Medicaid enrollment increases in direct proportion to increases in unemployment, he said.

Contact Capital Bureau Chief Ed Vogel at evogel@reviewjournal.com or 775-687-3901. Contact Annette Wells at awells@reviewjournal.com or 702-383-0283.

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